Policy offers recommendations for care of LGBTQ youth

Normal, just different

LGBTQ teens usually are resilient and often emerge from adolescence as healthy adults, the policy states. However, homophobia and heterosexism can contribute to health disparities. LGBTQ youth have higher rates of depression, substance abuse and sexually transmitted diseases. Sexual minority youth also are more likely to be sexually active than heterosexuals, increasing their risk for sexually transmitted infections (STIs).

The theme of the policy statement, said lead author David A. Levine, M.D., FAAP, is that “this doesn’t pathologize sexual minority youth.”

“These are children that are normal; they are just different,” he said.

While LGBTQ youth are different, Dr. Levine said that doesn’t mean they have health or psychosocial problems. At the same time, pediatricians need to be aware of how circumstances that LGBTQ youth face in daily life may play a role in their patient’s health.

This population needs a pediatrician’s support, Dr. Levine said, and doctors can make an important contribution through their efforts.

“Sexual minority youth need honest answers and compassion in dealing with issues and questions around sexual orientation, identity and sexual behaviors,” according to the technical report.

Pediatricians also should note that many adolescents who self-report as lesbian or gay may have sex with members of the opposite sex, and thus behaviors do not equal identity.

Establishing trust with patients

The Academy issued its first statement on sexual minority teens in 1983, with revisions in 1993 and 2004. Since the last report, research in this area has exploded.

Stigmatization and parental rejection are common among sexual minority youth, and struggles with self-image and self-esteem put these teens at risk, studies show. When teens “come out,” there often are significant repercussions and victimization. Two recent studies show 84% of open LGBTQ teens reported verbal harassment, 30% were physically assaulted and 28% dropped out of school.

Doctors can establish a good relationship with LGBTQ patients by using gender-neutral language when discussing sexual history, partners, friends or relationships. For example, pediatricians should ask a teenage girl, “Are you having sex?” instead of, “Are you and your boyfriend having sex?” Dr. Levine suggests the phrasing, “Tell me about your partner,” instead of using the term boyfriend or girlfriend.

The use of neutral language will help pediatricians establish trust with LGBTQ youth. With communication lines open, pediatricians then should work to ascertain a teen’s major risk behaviors and psychosocial concerns. For teens who are sexually active, and especially for those with multiple partners, STI testing should occur and contraception use should be emphasized.